ABSTRACT
Background: We previously demonstrated that utilization of a Remote Patient Monitoring (RPM) program - characterized by the use of in-home technology for symptom and vital signs assessments with a centralized care team responding to alerts - is associated with a significant reduction in 30-day hospitalization rate among cancer patients with COVID-19. We have subsequently performed a 90-day comparative cost-of-care analysis in this prospectively enrolled, validated cohort of 71 patients who received RPM and 116 patients who received usual care without RPM. Method(s): Primary outcomes included 90-day all-cause costs (categorized as hospital and outpatient costs) following the index date (date of COVID-19 diagnosis). Differences in patient characteristics and baseline costs (incurred 90 days prior to index date) were determined using Standardized Differences and controlled for using Inverse Probability Weighting (IPW). IPW balancing was based on baseline covariates known to be associated with poorer COVID-19 outcomes, as previously described. Association of costs with RPM was examined by generalized linear modeling while adjusting for relevant variables. Outcomes are reported as the average treatment effect on the treated (ATET). Result(s): Differences in patient characteristics and baseline costs were well-balanced following IPW modeling. The index ATET was found to be comparable among patients receiving RPM and usual care on the date of COVID-19 diagnosis -$89.75 (95% CI: -$144.33 to $323.84;p = 0.452). However, patients receiving RPM experienced a 90-day ATET of -$6,994 (95% CI: -$14,635 to $646;p = 0.073) when compared with patients receiving usual care. Conclusion(s): There was a trend towards decreased 90-day all-cause costs for cancer patients with COVID-19 who utilized the RPM program as compared with usual care. Larger studies are needed to understand the true cost (and cost savings) associated with this innovative model of care delivery which can be leveraged for cancer care beyond COVID-19.
ABSTRACT
Background: In response to the COVID-19 pandemic, many cancer practices adopted telehealth, including telephone and video appointments. Following a period of initial expansion that began in March 2020, sustained telehealth integration has emerged across the Mayo Clinic Cancer Practice (MCCP) in 2021. The primary objective of this study was to identify factors associated with utilization of telehealth appointments. Methods: A cross-sectional, multi-site, retrospective analysis was conducted across MCCP - a multisite, multiregional cancer practice with tertiary referral campuses in Minnesota, Florida, and Arizona, as well as rural, community-based hospitals and clinics throughout the Upper Midwest. Multivariable models were used to examine the association of patient- and provider-level variables with telehealth utilization. Results: Outpatient appointments conducted in July - August 2019 (n = 32,932) were compared with those from 2020 (n = 33,662) and 2021 (n = 35,486). The rate of telehealth appointment utilization increased from <0.01% in 2019 to 11.0% in 2020 and 14.0% in 2021. The strongest provider-level predictor of telehealth utilization was female physician provider type (OR 1.06, 95% CI 1.01 to 1.11;P = 0.0297), a trend consistently observed across career stages, practice locations and settings in 2020 and 2021. Additionally, while the rate of telehealth utilization was not significantly different at referral and community-based campuses in 2020, providers at referral campuses were significantly more likely to utilize telehealth than community-based campuses in 2021 (OR 1.1, 95% CI 1.01 to 1.12;P = 0.0289). Regarding patient-level factors, rural residence (defined by Rural-Urban Commuting Area codes), which accounted for 44.2% of the patient population, was significantly associated with lower telehealth utilization as compared to patients with urban residences, particularly for video appointments (OR 1.04, 95% CI 1.02 to 1.07;P < 0.0001). Notably, the disparity in telehealth utilization between rural and urban populations was found to be less pronounced in 2021 as compared to 2020. Conclusions: Multivariable analysis across a multi-site, multi-regional cancer practice identified several factors associated with increased telehealth utilization. These included female physician provider type, referral-based campuses, and patients residing in urban settings. A detailed understanding of the factors that influence telehealth utilization - a method of care delivery which represents a “new normal” across many cancer practices - will be essential to enable continued equitable access to high-quality, high-impact, patient-centered cancer care.